The Efficacy And Long-term Prognosis Of Mycophenolate Mofetil In The Treatment Of Proliferative Lupus Nephritis

Objective:To retrospectively analyze the efficacy of mycophenolate mofetil(MMF)in the treatment of different types of proliferative lupus nephritis(LN)and long-term prognosis of different duration of MMF maintenance therapy.Methodology:Two hundred twenty-nine patients with biopsy-proved Class ???and ?/?+?were enrolled in this study.All received prednisolone and MMF as induction immunosuppression.Patients were divided into three groups:long-term MMF maintenance group(group ?:the duration of MMF maintenance therapy ?24 months)?short-term MMF maintenance group(group ?:the duration of MMF maintenance therapy<24 months)?non-MMF maintenance group(group ?:change to other immunosuppressant for maintenance therapy).Response of induction therapy was divided into complete remission(CR)?partial remission(PR)?no remission(NR).The composite renal endpoint included end-stage renal disease(ESRD),creatinine doubling or decrease in eGFR>50%.SPSS 22.0 statistical software was used to analyze the efficacy of MMF treatment and compare the recurrence rate and the long-term prognosis of different group.Result:Two hundred and fourteen patients(93.4%)responded favorably(complete or partial remission)to induction treatment.The incidence of complete remission was 61.1%.Patients with mixed Class III/IV+V LN had significantly lower remission rate than patients with Class III/IV LN.There were 84 cases,84 cases and 28 cases in group 88(54.25,111.5)months,84.5(33.5,104)months and 79.5(33.25,116.25)months,respectively.The duration of MMF therapy was 50(37,72.5)months,16.5(12,22.75)months and 8(7,9)months,respectively.During follow-up,Sixty-eight patients(34.7%)relapsed.In group I,the rate of relapse was significantly lower than that in group II and group 111(22.6%vs 44.0%vs 42.9%,P<0.05).Multivariate analysis showed that the hazard ratio of relapse for group II was 2.13(95%CI 1.01?4.47,P = 0.046)and 3.25 for group ?(95%CI 1.83?5.76,P<0.00 1)when compared with group ?.The hazard ratio of relapse for those receive partial remission was 1.86(95%CI 1.10?3.16,P = 0.021)when compared with those receive complete remission.Eighteen patients reached the endpoint,include ESRD(n=1),creatinine doubling or decrease in eGFR ? 50%(n=17).Group I showed lower incidence of composite renal endpoint than group? and group ?(7.1%vs 10.7%vs 10.7%,respectively,P>0.05).Conclusion:Corticosteroids with MMF was effective for treating proliferative LN(?),but the treatment of V type of proliferative LN remission rate is lower.Long-term MMF maintenance after remission can achieve better sustained remission rate,long-term MMF treatment can reduce the relapse and the incidence of end-events.